Improvements in cancer treatments are a great success story resulting in a reduction in cancer mortality despite an ever-increasing number of people being diagnosed. (Office for National Statistics, 2018). Two out of three patients will receive Systemic Anti-Cancer Therapy (SACT). With more lines of treatment, regimes are becoming more complex, a skilled competent workforce is required to deliver this as part of ensuring that patients receive equitable and holistic care when they are treated (NHS England, 2013).
The 2020 Royal College of Radiology workforce census into UK Clinical Oncology highlights the ongoing workforce shortages putting consultants and departments under intense pressure, and negatively impacting the quality of patient care.
Chronic workforce and skills shortages have contributed to the rising number of patients unable to receive adequate cancer care and treatment. The management of cancer in the UK has rightly been identified as a governmental priority, based on the burden of suffering for individuals and their families and the economic consequences of cancer within the health system and wider society.
COVID has shown the ability of NHS clinicians to work together and repeatedly deliver over and above. A cancer tsunami of some sorts is expected in the coming months, owing to the delays in diagnosis due to the restrictions imposed during the pandemic. As the medical world braces for the forthcoming cancer wave, Professor Andrew Wardley insists that by expanding outreach cancer services and working with the communities will help clinical teams get ahead of the curve.
While new systemic anti-cancer therapies, investigated and tested in clinical trials, have been one of the main drivers of improved cancer outcomes, access to these trials is often restricted to centres with a record of accomplishment in delivering the required standard of care and quality. The variation in access also extends to standard of care treatments, likely as a consequence of local treatment habits, capacity and policy. Studies show that people living in underserved communities have worse access to cancer diagnosis and treatments, affecting their survival rates. Late diagnosis negatively impacts the economy as a whole.
Health Education England (HEE) has produced a comprehensive cancer workforce plan that sets out how it will make sure the NHS has enough staff with the right skills to deliver improvements for people affected by cancer over the next three years. This is a great start. It takes a minimum of 4 years to train an oncologist and urgent reforms are required before excellent new doctors become available. The rate of increase in demand for new treatments (The number of patients receiving Systemic Anti Cancer Therapies (SACT) is increasing (5). The NCRI estimates that the number of patients requiring SACT will increase by 58-81% between 2015-2045) and variation even in safe delivery and support for patients demands urgent attention.
Long overdue investment in workforce expansion is only part of the equation. Restructuring and a major change in culture in the NHS are equally essential. Prof Wardley states “The NHS needs radical action to improve working conditions, boost training and retention and become a ‘model employer’ for staff.”
Taking the learning system failures in the UK Outreach Research & Innovation Group has partnered with like minded innovation companies to access the untapped innovation potential of global clinicians to drive improvements in international partnerships to improve healthcare access and learning.
A comprehensive global survey of the clinical oncology workforce was conducted. Eight countries had no clinical oncologist available to provide care for patients with cancer. In 22 countries (24%), a clinical oncologist would provide care for 500 patients with cancer. In 27 countries (29%), a clinical oncologist would provide care for > 1,000 incident cancers, of which 25 were in Africa, two were in Asia, and none were in Europe or the Americas.
The economic and social development status of a country correlates closely with the burden of cancer and the shortage of human resources.
Addressing the shortage of clinical oncologists in regions with a critical need will help these countries meet the sustainable development goals for noncommunicable diseases by 2030.
With over 25 years of experience in developing integrated models in cancer care, the Group founder, and CEO of Outreach Research & Innovation Group, is setting out to drive system changes and look at a global ecosystem within cancer care. Prof Andrew Wardley has been in the vanguard of improvements in cancer treatments, through partnerships with international research clinical research organisations and collaborative groups, NIHR, NCRI, NICE and the NHS England chemotherapy clinical reference group. His ideas have been adopted by the European Cancer Code of Practice and NHS England.
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